How Urologists Manage Erectile Dysfunction after Radical Prostatectomy: A National Survey (REPAIR) by the French Urological Association

Abstract

Introduction There is little sound information on how urologists manage erectile dysfunction (ED) arising after radical prostatectomy (RP) in a real-world situation. Aim To perform a national survey of how French urologists manage ED after RP in routine practice. Main Outcome Measures Choice of first-line treatment, type of treatment (rehabilitation of erectile function vs. treatment on demand for intercourse), and timing and duration of treatment. Methods All French urologists were invited to take part in a survey; 59.7% accepted provisionally (760/1,272). They received the survey questionnaire and 10 patient data forms to be completed during the visits of the first 10 patients with fewer than 12 months follow-up post-RP. These were returned to an independent third party for analysis. Results The final response rate was 535/1,272 (42%). Before performing RP, 80% of the urologists assessed sexual activity and 76% erectile function; 9% did neither. Thirty-eight percent reported that they systematically proposed ED treatment to their patients post-RP (“routine prescribers”). The remainder was treated on occasion, either at the patients' request (49%) or at their own discretion (13%). Routine prescribers tended to be younger and had performed more RPs in the preceding year. Most urologists (88%) always used the same first-line treatment: regular intracavernosal injections (ICIs) for rehabilitation, 39%; ICI on demand for intercourse, 30%; phosphodiesterase type 5 (PDE5) inhibitors on demand, 16%, or regular PDE5 inhibitors for rehabilitation, 8%; alternating ICI and PDE5 inhibitors, 7%; vacuum device, <1%. ED treatment was initiated within 3 months of RP by 72% of the urologists (92% of routine prescribers). The percentage of urologists recommending ED treatment for 6 months was 20%, 38% for 1 year, and 33% for 2 years. Conclusion ED was commonplace after RP. French urologists reported a proactive attitude to ED treatment, many favoring pharmacologic rehabilitation therapy. ICI was their first-line treatment of choice.

Vacuum therapy in erectile dysfunction—science and clinical evidence

“…55,[63][64][65] Currently, PR methods include the use of PDE 5 I, intracavernosal self-injection/intraurethral suppositories, VED or a combination of different therapy modalities. 55,[63][64][65] Pathophysiology Erectile function (EF) becomes impaired immediately after RP secondary to cavernous nerve damage during surgery, resulting in neuropraxia. 66 Even with the most meticulous nerve-sparing dissection, some degree of neuropraxia is unavoidable because of the close proximity of the nerves to the prostatic gland.…”

Erectile dysfunction and sexual health after radical prostatectomy: impact of sexual motivation

“…Even so, according to a recent survey in France, only 38% of urologists routinely offer some form of pharmacological penile rehabilitation after RP, whereas 87% of the International Society for Sexual Medicine practitioners do so, with those managing over 50 RP patients per year being the most proactive. 3,4 In addition, even if erections are restored after RP, with or without treatment, sexual bother increases after RP and sexual health most often does not return to its preoperative level. 5 The aim of this study is to assess the impact of RP on patients' sexual health and satisfaction according to sexual motivation.…”

A comparison of different oral therapies versus no treatment for erectile dysfunction in 196 radical nerve-sparing radical prostatectomy patients

“…7,15 Despite this ongoing controversy, supportive evidence from animal studies continues to emerge, 16 and there is evidence that penile rehabilitation is widely used in everyday clinical practice. 17 Giuliano et al 18 explored practice patterns of French urologists and found that 488% used some form of early therapy after RRP, such as regular intracavernous injection (ICI) for rehabilitation (39%), ICI on demand for intercourse (30%), PDE5-Is on demand (16%) or regular PDE5-Is for rehabilitation (8%), alternating ICI and PDE5-Is (7%) and vacuum devices (o1%).…”